In chapters 1-8 we carried out the first two objectives of
this document, to review the literature on research pertinent to
the family in five disciplines and to formulate and test an
integrated empirical model of family characteristics that
determine child welfare and development. In this chapter we use
the findings from the literature and our own analyses to propose
and support a definition of family social wellness. We propose
models for testing and using this definition for the design and
evaluation of policies and programmes. Finally, we discuss
research approaches and tools needed to support a family social
health approach to development assistance.

Viewed together, the family literature provides consistent
criteria for defining family social health, wellness, or
well-functioning that could be subdivided in a variety of ways.
For the purposes of providing assistance to socio-economic
development, we choose to group them under four dimensions that
roughly correspond to four different domains of policy or
intervention approaches. These dimensions also show an
approximate congruence with the four spheres of action designated
by the Family in Development initiative of the Agency for
International Development (AID): the family as an economic
system, the family as a social and biological reproductive
system, political choices and the family, and families at risk
(Agency for International Development 1991).

1. Family management, including skills in accessing
and managing resources needed to sustain the family under
normal conditions and during crisis (food, money, shelter,
transportation, health care, education, etc.), and skills in
governance of the family as a cooperative unit
(decision-making, bargaining, problem solving).

2. Family caring capacity, characterized by
sensitive and loving transactions between family members and
by adequate technical knowledge and caring skills in physical
maintenance, nutrition, health, socialization, and education.

3. Family beliefs, rules, and goals including
explicit and implicit ideals and values for the family
itself, goals for individual members, resource-sharing rules,
cultural rules and codes for family behaviour, perceptual
frameworks, and cognitive interpretations.

4. Family boundary maintenance, or structural
integrity, covering the formation and dissolution of
reproductive partnerships, birth control, child custody and
fostering, the launching of adult children, care arrangements
for the elderly, temporary separation, and death.

These dimensions are embedded in the family's interactions
with its ecological context, and must also be considered from the
perspective of family stage in the life cycle (Walker and Crocker
1988). The international development assistance field should find
the contextual considerations familiar, as far more attention
already has been given to the contextual community level than to
families themselves.

We used our data on families in Indonesia and Nigeria to
create the empirical models (see ch. 8) that illustrate the
importance of social health at the family level. These models
support the above definition, although the studies were not
designed to gather data explicitly on each dimension. Our data
sets included many covariables of malnutrition and mental
development (demographic, social, economic, attitudinal, and
behavioural) and these covariables showed expected modest
correlations with growth and cognitive test scores. We found that
models using these variables to measure the quality of family
functioning (social health) and to explore the effects of family
social health on the children's overall development showed
stronger and more meaningful associations than the one-on-one
relationships. We interpret these findings as an indication that
family-level interventions that improve the child's total
condition are likely to be more effective than vertical
programmes that influence only one aspect at a time.

Family management enables the family as a unit to acquire and
manage resources consistent with its goals and cultural codes. We
call this "management," rather than "coping,"
because psychologists use the term coping to refer to only one
aspect of management, the response to crisis. The management
dimension of family social health corresponds to the AID sphere
of the family as an economic system. It includes McMaster's
"basic task area" (see Epstein, Bishop, and Baldwin
1984): earning a living, day-to-day home economics, planning, and
seeking to take advantage of social services and new business
opportunities. Proactive, upwardly mobile management styles are
associated with favourable child outcomes. Although our model
data were not collected to test the family management dimension,
a number of our academic and health care measures reflect its
presence.

This dimension, which corresponds to the family as a social
and biological reproductive system, has a loving and fun-loving
component and a micro-level competency component: these include
knowing how to breast-feed, play peekaboo, soothe a crying child,
be sensitively verbally responsive, tell a story, prepare oral
rehydration therapy, and clean a skin puncture; knowing when to
go to the doctor; knowing how to protect food and kitchen
utensils from animals. It captures the capacity to enhance and
celebrate living through microlevel transactions between domestic
partners, their children, and others.

The affective aspect of caring capacity involves management at
the micro-level, where the behavioural transactions between
individuals cross the perceptual boundary from "doing"
to "being," as in "being" empathetic, warm,
and sensitively responsive. The technical aspect includes child
stimulation, nutrition, health care, sanitation, family planning,
and other teachable skills - the common topics of parent
education programmes.

The beliefs, rules, and goals of the socially healthy family
provide a support structure for economic success for both parents
and children. They facilitate resource sharing and forward
planning, which benefit all members. They are rooted in society's
concepts of the ideal family, in cultural value systems that draw
support from the cultural contexts of the community and society.
Concerns for these value systems at the societal level correspond
to AID's sphere of political choices and the family.

These values and ideals have an altruistic and an artistic
component, reflected, for example, in the Yoruba proverbs about
parenting (ch. 7), in pictures of the Madonna and Child, as well
as in pictures by Norman Rockwell. Cultural ideals for the family
give meaning to life. The ability to fulfil them is a criterion
for judging the success of life itself. Cultural periods
remembered as golden ages have been defined by the quality of
family life.

Importance of cultural paradigms, legal and social
entitlements, and cognitive interpretations

Research literature across the social sciences shows that
important determinants of family social health include cultural
and religious ideals and values, individual beliefs, and the
"fit" between these paradigms and the social conditions
required for economic prosperity. These paradigms are expressed
in family law, social welfare entitlement, family size
limitation, parenting codes, cognitive interpretation of events,
and in gender and age-specific conventions for intra-household
resource and task allocation. Examples of evidence from the
literature include:

1. Sociology: continuing dialectic between
socio-economic conditions, values, laws, and lifestyle
prescriptions; negative effect claimed for values of
capitalist economy on social responsibility; positive effects
of US medical establishment's diet and exercise prescriptions
on mortality indicators; dialectic process illustrated by
current US debate over abortion.

2. Anthropology: many examples of resource
allocation rules that negatively and positively affect
categories of individuals. Observation that children in
certain modernized cultures are less responsible and
altruistic than children in more traditional societies.

3. Household economics: recognition that implicit
cultural contracts and legal and institutional factors that
determine the disposition of household assets, such as family
laws regarding property rights and social entitlements, play
a greater role in intra-household resource allocation than
active bargaining among family members ("shoot-out at
the family corral").

4. Psychology: the extreme resistance to change of
male gender roles in dualearner households in the United
States where the wife earns as much as the husband but
continues to perform most domestic tasks; the finding that
the main determinant of why some families cope while others
fall into crisis under similar stress is the meaning that the
stressful event holds for the family and the individuals
within it.

5. Development assistance: international assistance
agencies historically have been careful to remain neutral in
their approach to values in order to build consensus across
cultures. Ideologies put forth by these agencies, such as
Child Survival, have played a major role in shaping
programmes and effecting evaluation indicators. With the
worldwide movement towards deepening democratic reform,
however, AID (1991) has recognized that cultural adjustment
of legal and social structures is needed to reduce
intrafamily inequities.

The cultural renewal process: How paradigms change

The renewal process by which cultural value systems adapt to
support socio-economic improvement also can be considered as a
form of "cultural adjustment" that is needed in
parallel to structural adjust ment. Historically, cultural
paradigms of the family change from within through a dialectic,
self-corrective process. Opinion leaders within the culture
formulate and voice these changes. Ideologies co alesce around
political and economic forces and the mood of the times; they
both respond to and are precognizant of socio-economic change.
Certain orientations have deep cultural roots, as for example the
3,000-year-old Jewish tradition. Other social trends appear as
chaotic as the weather. Cultural consensus continually reshapes
from within.

Positive change in culture-wide codes, such as healthful diet
changes in the United States, appear to occur when the local
intelligentsia first develops and articulates the new codes
through consensus building in professional circles and then
through the media, social services, and legislation, with ongoing
feedback via professional meetings and journals and mass
communications.

Studies of changing parenting codes also reveal a
self-regulating, adaptive process when underlying resources are
sufficient to permit families to regenerate. The greater the
cultural distance between the traditional and modern lifestyles,
the greater the paradigm shift required. In many of the world's
poorest countries, cultural renewal has not kept pace with social
change because of the dearth of resources available to the
intelligentsia, which must formulate and legitimize new codes.
Such moral rearmament activities are trivialized and ring hollow
when they are left solely to the propaganda wing of the
government in power. Cultural reconstruction becomes deadlocked
by conflict between social profitability for the culture as a
whole and the survival needs of its individual families. Values
supporting small family size, for example, cannot prevail as long
as individual families cannot afford to limit the number of their
children. Cultural renewal also is deadlocked by resistance to
necessary reductions or downward adjustments of entitlement to
groups who continue to hold power.

In the most seriously affected parts of the world, moral codes
developed over millennia of social evolution have disappeared
with the lifestyles they supported. The absence of adequate
cultural renegotiation and regeneration by legitimate opinion
leaders has produced social conditions resembling cultural
wastelands, over which unprincipled profiteers, degenerate gangs,
and religious fundamentalists vie for control. Chapter 10
suggests actions that may assist developing countries in cultural
renewal.

Flexible boundary maintenance, adapting to changing life-cycle
needs, is a characteristic of well-functioning family systems.
Involuntary boundary problems occur during armed conflict, sudden
death, migration to find paid employment, and extreme poverty
that forces reproductive partners to abandon each other and their
children. Pathological boundary crises include male abandonment
and separation leading to female-headed households; extramarital
or conflicted polygamous relationships; struggles over child
custody, support, and fostering; contested inheritance and
property rights; and predation by some family members on others.
These pathologies often involve problems with boundaries between
family members, reflected in violence, sexual abuse, and
dysfunction involving substance abuse. Families classified
"at risk" typically have boundary problems.

Instrument development for the evaluation of family support
and parent education programmes is still in its infancy. Krauss
(1988) reviewed more than a dozen measurement instruments that
have attempted to assess family functioning. Use of these tools
has resulted in inconclusive outcomes and generally has failed to
establish hard links between programmes, family measures, and
individual wellbeing. Nevertheless, these instruments provide a
smorgasbord of concepts and items to be considered in future
research.

The use of a family social health approach in programme design
and evaluation calls for new modelling procedures that assess the
following:

1. How family social health determines the demand for
inputs provided by programmes;

2. The impact of those inputs on the family as a whole and
on individual family members;

3. The effects of family social health on child outcomes
under conditions of changing inputs.

This formulation draws on ideas expressed by Berman, Kendall,
and Bhattacharyya (1994). The best ways of accomplishing this
task require further discussion. Dunst and Trivette (1988), for
example, use hierarchical regressions and canonical correlations
for family systems analysis. We suggest the development of
structural latent variable models similar to those presented in
chapter 8, but which incorporate certain desirable features of
regressions. The coefficients in the models in chapter 8 cannot
be used to estimate effect sizes. These models were not designed
to incorporate policy variables (e.g. government expenditure on
education and other programmes created outside the family). The
hybrid models that we propose would permit prediction of the
impact of different levels of programme resources on targeted
outcomes, but would continue to take into account the integrity
and complexity of the family system. Such models would
incorporate both supply and demand relationships. The UNICEF
conceptual framework might serve as a starting point for
conceptualizing analyses that test the effects of multiple
existing vertical programmes on households and families.

The boundaries between the methods and orientations of the
different social sciences increasingly overlap. This merging of
disciplines with a redefinition of paradigms has been claimed to
be a part of the trend towards "dedifferentiation" in
the post-modern era (Lash 1990). For policy-related work,
disciplinary interests recede in importance as the topics of
study spring into the foreground. The family is a topic that
demands this blending and synthesis of methods. In fact, the
family could prove to be the best single topic for
interdisciplinary methodological development, because
within-disciplinary methods for family studies already are well
articulated and explored, providing a tested menu of methods and
results to contrast and compare.

Fields that are multidisciplinary in origin, such as
international nutrition and food policy, may be at the forefront
of disciplinary pluralism. The same nutrition-related theses are
produced by academic departments of nutrition, epidemiology,
international health, psychology, human development, human
biology, sociology, anthropology, economics, and demography.
Social scientists working in these already multidisciplinary
fields may be more experienced and objective in bringing a
cross-disciplinary perspective to the family than researchers
based in disciplines with long-established family studies.

New greatly increased computing capacity invites statistical
analysis plans that draw eclectically from the various
disciplines and synthesize elements from them into increasingly
comprehensive explanatory models. For example, endogeneity -
bidirectional flow of causality previously modelled by
econometricians - now can be taken into account in
epidemiological models using packaged programs for simultaneous
logistic regression. Conversely, the structural equation models
that we find in psychological research can be adapted along
econometric lines to permit cost-effectiveness estimates for
varying development inputs, as we suggest above.

Antecedents of new, more inclusive modelling may be drawn from
systems modelling in development studies that began in the early
1970s. The international nutrition planning movement provides a
relevant example. In the second half of the 1970s,
multidisciplinary research teams in institutions in both
industrialized and developing countries designed elaborate
cross-disciplinary conceptual frameworks. In the late 1970s and
early 1980s, disenchantment with the mathematical modelling
capabilities of the time, and failure to couple systems theories
to action, swung the pendulum towards less formal and less
quantitative approaches to operational research and evaluation,
in which the systems relationships served as conceptual
frameworks.

As the moment approaches when numerical methods will be able
to keep pace with programmatic action, the attempt to quantify
cross-disciplinary theory building re-emerges as a central
priority. The current and coming generations of computers provide
sufficient computing power for a quantum leap in statistical
social science applications. These applications have the
potential for creating portable computer field tools that remove
many of the time lags and much of the guesswork from global
monitoring and development assistance. Many of the component
pieces and features that should be incorporated into these
applications already are evident. What has fallen furthest behind
is statistical programming. A new, well-publicized
crossdisciplinary statistical programming agenda for the social
sciences is critically needed to stimulate the creation of the
needed software packages.

This call for theoretical and statistical research and
development is applications driven. Computers of the new
generation already are in our homes and overseas field offices,
where their potential is underused. The payoffs for such
development work should be comparable to the increments in
efficiency gained by moving from boat mail to airmail to fax to
e-mail. We suggest that the following should be done:

1. Develop an intradisciplinary research team on the
family to:

(a) Evaluate cross-disciplinary findings and formulate
new theories based on this evaluation.

(b) Determine research agendas and data analysis
needs.

2. Hold a meeting of statisticians serving these
disciplines to define statistical research and computer
software development to meet the needs of the research
agenda. Work will be needed in the following areas:

(a) Non-parametric, non-linear, and robust versions of all
multivariate procedures, such as partial correlation,
multiple regression, ANCOVA, MANOVA, to deal with data not
nor mally distributed, or non-linear, and that may have
problematic outliers. At present, statistical software for
univariate analysis copes with these issues whereas software
for multivariate analysis does not, with very few exceptions.

(b) Easy-to-use jackknifing procedures that permit
accurate estimation from smaller samples (essential for field
procedures too burdensome to conduct on very large samples).

(d) Better methods for dealing with statistical
significance when conducting multiple tests on large sets of
variables - e.g. more programs for specifying combined
variable models for testing subsets of coefficients together
(methods that do not demand data normality).

(e) Methods or rules for making multivariate models more
robust in that the coefficients they produce need to become
less sensitive to the entry or removal of individual
variables. In the present state of the art in model building,
the almost arbitrary addition or removal of individual
variables from a large data set can create almost any outcome
desired by the data analyst.

(f) Better programs for sequence recognition and for
analysis of interactive systems.

(g) Better software for qualitative data analysis in
formats that can be merged with quantitative data sets.

(h) Management information systems (MIS) applications that
conduct more automatic data quality checks and that have
built-in multivariate analysis programs, customized to the
MIS data and robust against the effects of outliers.